Tomorrow's New York Times is due to contain a frightening story about why so many Indian children end up malnourished even though they're fed fairly well by Indian standards. The reason? Unsanitary living conditions.
The Times follows Vivek, a toddler living in Sheohar, a small village in the state of Bihar near the Nepali border. Even though his home is full of an ample amount of food and his mother breast-feeds him, doctors diagnosed him with malnutrition--mainly because he and others in his village are forced to go to the bathroom in conditions that can charitably be described as primitive.
Like almost everyone else in their village, Vivekand his family have no toilet, and the district where they live has the highest concentration of people who defecate outdoors. As a result, children are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat.
“These children’s bodies divert energy and nutrients away from growth and brain development to prioritize infection-fighting survival,” said Jean Humphrey, a professor of human nutrition at Johns Hopkins Bloomberg School of Public Health. “When this happens during the first two years of life, children become stunted. What’s particularly disturbing is that the lost height and intelligence are permanent.”
Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problem.
This makes sense. It takes a lot of energy to fight disease, as most of us who have had bouts with the flu know all too well. And it makes even more sense considering that the immune systems of most people in the developing world are nowhere near as strong as those in the developed world.
For years, international organizations were dumbfounded--how are kids in India more malnourished than their counterparts in the Democratic Republic of the Congo or Somalia, even though those countries are far poorer than India. Apparently the answer lies in India's high rate of open defecation. Almost half of the country's people go to the bathroom outdoors, in apparent obedience to Hindu texts calling for people to relieve themselves as far from home as possible.
No less a personality than Gandhi realized this could be a big problem--but millennia of tradition are hard to break. In Sheohar alone, 80 percent of the population defecates outdoors. Not even major cities like Mumbai, Chennai and Delhi have wastewater treatment systems that even approach the scale of the ones in the developed world, so most of Indian rivers are some of the most polluted bodies of water in the world. It's even more staggering when you consider that in neighboring Bangladesh, only three percent of the population goes to the bathroom outdoors.
India has tried to build more public toilets, but keeping them clean is another matter. For instance, in Varanasi, India's holiest city (owing to being on the banks of the Ganges), one public toilet has a clogged effluent pipe. The woman who maintains it charges two rupees for each use, forcing many children to relieve themselves in open drains.
Ramanan Laxminarayan, vice president for research and policy at the Public Health Foundation of India, says that India needs to spend a lot more money on improving sanitation. He noted that the country spends some $400 million on sanitation compared to over $26 billion on food and jobs--a ratio that he thinks needs to be reversed. But it's going to take a lot more than money to reverse something that seems to be deeply ingrained.